Kenpo Karate of Woodland Park,
Colorado
Welcome to
our Studio
Introductory
Application for Kenpo
Name
_________________ Date
____________ Email _______________
_____Male _______Female Age ______ Date of Birth _______________
(Parent
or Legal Guardian if under 18) Name _______________________________
Home
Phone Number ___________ Emergency Contact Number _________________
Address
____________________________________________________
Is
anyone else responsible for the decisions or the tuition for the lessons? ____YES
____ NO
If
YES, Who : ________________________________
How
did you find out about Kenpo Karate of Woodland Park, Colorado ______________
Learning
Objectives __Self Defense __Confidence
__Strength Building __ Weight Control __Sport
___Physical Conditioning ___Martial Arts Philosophy ___Meditation/Relaxation ___Discipline ___Tournaments/Competitions
___Stress Relief ___Bully Management
Waiver and
Release
I
hereby agree to participate in Kenpo Karate of Woodland Park, Colorado (the
school) martial arts & fitness programs given by its owners, employees and
agents, upon the understanding that:
1.
I represent to PHOENIX fitness & Kenpo Studio of Colorado Springs that I have no physical, mental or emotional illness that could impair
training or that could make the training injurious. While every effort will be made on the part
of the school to make the classes and facility as safe as possible, I realize
that any physical activity has the potential for injury and I waive any claim
of accidental and/or negligent tort against the school and its owner(s),
employees and agents resulting from this activity.
2.
I
also release the school from any liability arising from my use of any and all
equipment provided by the school.
3.
I
understand that I will also be held responsible for any negligent damage
(replacement/repair) to equipment I am using that is owned or provided by the
school.
__________________ ______________________ __________________
Student
Parent or Legal Guardian(if under 18) Witness
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